Khorana Alok A, Connolly Gregory C
James P. Wilmot Cancer Center, and Department of Medicine, University of Rochester, Rochester, NY, USA.
J Clin Oncol. 2009 Oct 10;27(29):4839-47. doi: 10.1200/JCO.2009.22.3271. Epub 2009 Aug 31.
Patients with cancer are increasingly at risk for venous thromboembolism (VTE). Rates of VTE, however, vary markedly among patients with cancer.
This review focuses on recent data derived from population-based, hospital-based, and outpatient cohort studies of patients with cancer that have identified multiple clinical risk factors as well as candidate laboratory biomarkers predictive of VTE.
Clinical risk factors for cancer-associated VTE include primary tumor site, stage, initial period after diagnosis, presence and number of comorbidities, and treatment modalities including systemic chemotherapy, antiangiogenic therapy, and hospitalization. Candidate predictive biomarkers include elevated platelet or leukocyte counts, tissue factor, soluble P-selectin, and D-dimer. A recently validated risk model, incorporating some of these factors, can help differentiate patients at high or low risk for developing VTE while receiving chemotherapy.
Identifying patients with cancer who are most at risk for VTE is essential to better target thromboprophylaxis, with the eventual goal of reducing the burden as well as the consequences of VTE for patients with cancer.
癌症患者发生静脉血栓栓塞（VTE）的风险日益增加。然而，VTE的发生率在癌症患者中差异显著。
本综述聚焦于近期基于人群、医院及门诊队列研究得出的数据，这些研究针对癌症患者确定了多种临床风险因素以及预测VTE的候选实验室生物标志物。
癌症相关VTE的临床风险因素包括原发肿瘤部位、分期、诊断后的初始阶段、合并症的存在及数量，以及治疗方式，包括全身化疗、抗血管生成治疗和住院治疗。候选预测生物标志物包括血小板或白细胞计数升高、组织因子、可溶性P选择素和D-二聚体。一种最近经过验证的风险模型，纳入了其中一些因素，有助于区分接受化疗时发生VTE风险高或低的患者。
识别出癌症患者中VTE风险最高的患者对于更好地进行血栓预防至关重要，最终目标是减轻VTE对癌症患者的负担及其后果。
